Sentinel node biopsy and radical lymph node dissection for advanced melanoma in the elderly

Articolo presente su PubMed Central. Sourcerecord Id Scopus: 28558 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194399/ Background.The majority of indications for surgery in melanoma are for the treatment of primary tumor and lymph node metastases. During the last decade, the Sentinel Node Biopsy (SNB), from a research procedure, has become standard of care in most institutions. SNB is normally considered for patients with melanoma > 1 mm and generally about 20% are positive; however, the risk of a positive SNB in a melanoma < 1 mm is still 5%. Usually when SNB is positive a complete lymphadenectomy is performed. Materials and methods.In the period 2004-2009, 18 elderly patients (median age 68 years) affected by cutaneous melanoma (mean Breslow’s thickness = 3.77 mm), after SNB histologically confirmed regional lymph node involvement, underwent complete lymph node dissection (CLND). We treated 11 of them with groin dissection, in 3 cases bilateral; 4 patients underwent axillar dissection, in one case bilateral; 2 patients underwent neck dissection and another patient underwent groin-axillar dissection. We treated bilateral groin involvement with laparoscopic access for dissection of lumbar-aortic, iliac and obturator lymph nodes. Results.Disagreeing with literature, 12/18 (67%) of these patients had positive lymph nodes, a high percentage if compared with younger patients’ data. Currently the average follow-up is 25 months. In our sample CLND has a crucial prognostic role (16% vs 41% of deceased in CLND – and CLND + patients respectively). Conclusions.Elderly melanoma patients are characterized by a higher tumor stage and, in patients with nodal metastases, the prognosis is independently affected by older age. In case of positive SNB the CLND plays a notable prognostic role and a presumable therapeutic role

TEM in the treatment of recurrent rectal cancer in the elderly

Articolo presente su PubMed Central. Surcerecord id Scopus 28558 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194378/ Introduction.Transanal endoscopic microsurgery is a useful technique of minimally invasive surgery that allows the realization of complex interventions, from transanal excisions to full thickness resections with anastomotic reconstructions. TEM can have a diagnostic and therapeutic value in the elderly for the treatment of primary rectal cancer as well as for recurrences. Materials and methods.During the period between January 2002 and December 2009 six patients, average age of 66 years, four men and two women, with early diagnosed rectal cancer recurrence were selected to undergo this palliative surgical procedure. 3 men and 1 woman underwent "ultra-low anterior resection”, followed by chemo / radio therapy (T3N1M0); in one woman a TEM (T1NxM0) and in one old man the local escission was performed after neoadiuvant chemo/radio therapy (T2NxM0). The selection of the patients was made by: rigid sigmoidoscope, transrectal us, colonoscopy, abdominal us to rule out liver metastases, CT and MRI abdomen and pelvis with and without contrast agents, PET CT. In all patients the lesions were superficial, smaller than 2 cm and located at the posterior wall of the rectum. Results.Follow-up was approximately 12-28 months; the pathologic staging confirmed the complete excision of recurrences. Patients were then referred for more complementary therapies. Only one patient presented a retro rectal abscess treated with conservative techniques, too. Conclusions.The alternative to conservative surgery is an abdomino-perineal resection sec. Miles, but also this really invasive procedure can be considered palliative in the most part of recurrences. So, based on equal oncological results, the reduction of surgical trauma and preservation of anatomical integrity are really important goals

Laparoscopy in bilio-pancreatic surgery in elderly

Articolo presente su PubMed Central. Sourcerecord id Scopus 28558 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194374/ Background.More minimally invasive techniques are currently available for the surgical oncologist in the optimal staging of biliopancreatic cancer. With the increased age of population we can see an increase of age-related diseases, such a cardiovascular disease, hypertension, arthritis and other malignancies. With the development of endoscopy, laparoscopy, ultrasonography and biopsy equipment, more minimally invasive techniques are currently available for the surgical oncologist to provide a better optimal diagnosis and strategy, followed by an appropriate surgical treatment of biliopancreatic cancer. Improvement in the diagnostic and surgical care of elderly cancer patients will have a final impact on disease and overall survival rates of the different types of cancer treatment. Materials and methods.We retrospectively reviewed the records of patients between January 2001 and December 2008 who had either a mass in the biliopancreatic area classified as clinically resectable. Tumours were considered to be resectable when there was no evidence of distant extra pancreatic disease or involvement of lymphnodes outside the classic margins of resections. Occlusion or encasement of the superior mesenteric artery or vein, celiac artery or portal vein were used as a criteria for unresectability. Twenty-eight patients over 65 and under 75 years (middle age 69) with primary biliopancreatic cancer were submitted to operations for potentially operative resection. In all cases staging laparoscopy was performed just prior to planned open exploration and resection. Results.Twenty seven patients underwent laparoscopy exploration for potential resection. Two of five patients (40%) with distal cholangiocarcinoma survived at 5 years after DCP. Eighteen patients (66.6%) had unresectable disease identified at laparoscopy and fourteen were able to convert to laparotomy palliative surgery while for the others laparoscopy spared an unnecessary laparotomy. In four patients it was possible to perform a laparoscopy palliative surgery. Conclusions.Laparoscopy may have a role in the staging of patients with biliopancreatic malignancies, in particular, for reduction of unnecessary exploratory laparotomy. Moreover, even in old age, duodenocephalopancreasectomy, properly planned and executed, resulted in reduction of operative mortality and morbility and a clear long-term survival

Comparazione dei metodi di valutazione della vulnerabilità costiera nella piana del Sele (Salerno).

La ricerca interdisciplinare degli ultimi 20 anni evidenzia il rischio da erosione che colpisce molte coste sottoposte ad arretramento e inondazione da parte delle azioni naturali. Le condizioni critiche di vulnerabilità costiera possono diventare più gravi in particolare nelle pianure costiere, che ospitano importanti centri urbani e industriali, infrastrutture e attività turistiche, spesso accoppiate con paesaggi tutelati e / o siti archeologici. Pertanto è necessaria una corretta valutazione della vulnerabilità costiera, tenendo conto sia della vulnerabilità da inondazioni costiere sia da erosione. In questo lavoro viene valutata la vulnerabilità da eventi meteomarini estremi della piana costiera del Sele (Salerno). La stima della vulnerabilità viene effettuata combinando sia l’erosione a breve termine che quella a lungo termine valutata attraverso una simulazione numerica delle onde e le caratteristiche morfo-sedimentarie della spiaggia. L'analisi dell’evoluzione costiera per effetto della tempesta è stata esaminata per mezzo di due indicatori, calcolati lungo un certo numero di profili di spiaggia realizzati tra il 2008 e il 2009: il wave run-up (come misura di inondazione costiera) e l’arretramento della spiaggia (come misura dell’erosione potenziale). Inoltre, l’evoluzione costiera a lungo termine è stata valutata attraverso i tassi di erosione derivati dal confronto di ortofoto in sequenze multi-temporali e multi-scala. I risultati sono stati espressi utilizzando diversi indici di vulnerabilità costiera, ottenuti sommando i punteggi relativi alla erosione a breve termine ea lungo termine. L'esame dei risultati finali ha evidenziato diverse risposte dei profili costieri in funzione dell’indice utilizzato

IMPLEMENTATION AND VALIDATION OF WAVE WATCH III MODEL OFFSHORE THE COASTLINES OF SOUTHERN ITALY

ABSTRACT The spectral third-generation ocean wind-wave model WAVEWATCH II

Coastal sensitivity/vulnerability characterization and adaptation strategies: A review

Coastal area constitutes a vulnerable environment and requires special attention to preserve ecosystems and human activities therein. To this aim, many studies have been devoted both in past and recent years to analyzing the main factors affecting coastal vulnerability and susceptibility. Among the most used approaches, the Coastal Vulnerability Index (CVI) accounts for all relevant variables that characterize the coastal environment dealing with: (i) forcing actions (waves, tidal range, sea-level rise, etc.), (ii) morphological characteristics (geomorphology, foreshore slope, dune features, etc.), (iii) socio-economic, ecological and cultural aspects (tourism activities, natural habitats, etc.). Each variable is evaluated at each portion of the investigated coast, and associated with a vulnerability level which usually ranges from 1 (very low vulnerability), to 5 (very high vulnerability). Following a susceptibility/vulnerability analysis of a coastal stretch, specific strategies must be chosen and implemented to favor coastal resilience and adaptation, spanning from hard solutions (e.g., groins, breakwaters, etc.) to soft solutions (e.g., beach and dune nourishment projects), to the relocation option and the establishment of accommodation strategies (e.g., emergency preparedness)

Characteristics and coastal effects of a destructive marine storm in the Gulf of Naples (southern Italy)

Destructive marine storms bring large waves and unusually high surges of water to coastal areas, resulting in significant damages and economic loss. This study analyses the characteristics of a destructive marine storm on the strongly inhabited coastal area of Gulf of Naples, along the Italian coasts of the Tyrrhenian Sea. This is highly vulnerable to marine storms due to the accelerated relative sea level rise trend and the increased anthropogenic impact on the coastal area. The marine storm, which occurred on 28 December 2020, was analyzed through an unstructured wind-wave coupled model that takes into account the main marine weather components of the coastal setup. The model, validated with in situ data, allowed the establishment of threshold values for the most significant marine and atmospheric parameters (i.e., wind intensity and duration) beyond which an event can produce destructive effects. Finally, a first assessment of the return period of this event was evaluated using local press reports on damage to urban furniture and port infrastructures

Monitoring and ming bio-physical parameters for hypoxia hazard in a coastal sand pit

Management of coastal areas requires monitoring and modeling of the anthropogenic drivers and the bio-physical processes affecting water quality. To assess the range of hydrographic conditions controlling oxygen distribution in the bottom layers of sand pits, a multi-year oceanographic survey has been conducted in a coastal area with several extraction pits. Hydrographic data including profiles of temperature, salinity and oxygen were collected and related to local wind conditions and circulation. Moreover, 1D and 3D high-resolution non-hydrostatic ocean models were used to describe turbulent mixing regimes and to obtain the range of wind speeds for which the critical anoxic conditions may occur. It is shown that wind speed appears to control the dynamics of oxygen concentrations, with oxygen depleted zones developing in a short time in low wind speed conditions. Moreover, the depth and the shape of the extraction pit contribute to decrease the mixing of the bottom layers and increase the water retention in the hole increasing the output and the persistence of oxygen depleted zones in the excavated area. The results of the numerical simulations show that the risk of hypoxia at the bottom of the sand pits is associated with higher temperatures and wind speed lower than 5 m/s, which is not infrequent during the summer season. However, the number of consecutive days of oxygen depletion can be considered lower than the danger threshold level assumed in the literature

Monitoring and Modelling Bio-Physical Parameters for Hypoxia Hazard in a Coastal Sand Pit

Management of coastal areas requires monitoring and modeling of the anthropogenic drivers and the bio-physical processes affecting water quality. To assess the range of hydrographic conditions controlling oxygen distribution in the bottom layers of sand pits, a multi-year oceanographic survey has been conducted in a coastal area with several extraction pits. Hydrographic data including profiles of temperature, salinity and oxygen were collected and related to local wind conditions and circulation. Moreover, 1D and 3D high-resolution non-hydrostatic ocean models were used to describe turbulent mixing regimes and to obtain the range of wind speeds for which the critical anoxic conditions may occur. It is shown that wind speed appears to control the dynamics of oxygen concentrations, with oxygen depleted zones developing in a short time in low wind speed conditions. Moreover, the depth and the shape of the extraction pit contribute to decrease the mixing of the bottom layers and increase the water retention in the hole increasing the output and the persistence of oxygen depleted zones in the excavated area. The results of the numerical simulations show that the risk of hypoxia at the bottom of the sand pits is associated with higher temperatures and wind speed lower than 5 m/s, which is not infrequent during the summer season. However, the number of consecutive days of oxygen depletion can be considered lower than the danger threshold level assumed in the literature

Sea-level rise impact and future scenarios of inundation risk along the coastal plains in Campania (Italy)

Sea-level rise as a consequence of global warming increases the need to analyze coastal risks to conceive adaptation strategies aimed at coping with marine impacts at both short- and long-term scales. In this context, this study presents future scenarios of inundation risk evaluated along the main alluvial coastal plains of the Campania region (Italy). Due to their geomorphological and stratigraphical setting, the investigated areas are characterized by low topography and relevant but variable subsidence rates. Based on the upgrade of already published data and the new analysis of available datasets derived by multi-temporal interferometric processing of satellite Synthetic Aperture Radar (SAR) images, future scenarios of local sea level for the years 2065 and 2100 have been evaluated coupling global projections with local subsidence trends. Furthermore, aspects related with the distribution of natural and anthropic assets, as well as the local social vulnerability, have been taken into account to calculate the overall risk. The inundation risk maps here proposed can effectively address the request to improve the knowledge of policymakers and local administrators and to raise their awareness about the potential impacts of climate change in coastal areas